Scrool Atarese Tesener O Serocl Contact Number/s: stugent O Philippine Society of Youth Science Clubs, Inc 2011 National Youth Science Technology and Environment Summer Camp Sarabia Manor Hotel & Convention Center, 101 General Luna St., lilo Gty ‘April 7-10, 2011 staple 2 pcs. sad plewres sex: OMe Dremate Home Addresses: Birthday sme-oo-ve): I] OO] CO Ralaionsi: contact Numbers PRINICIPAL’S ENDORSEMENT I certify that isa bona fide studentof _andis one of the school's official delegates to the 2011 National ‘Youth Science Technology and Environment Summer Camp. Signature over printed name of Principal MEDICAL CERTIFICATE I heraby certify that i have examined ‘and found him/her physically eto join the 2011 Wational Youth Science Technology and Environment Summer Camp. Signature over printed name of Physician PARENTAL CONSENT. | hereby allow my son/daughter to participatein the2012 NationalYouth Science Technelogy and Environment Summer Camp. | will not hold the organizers responsible ‘to any accident that may happen beyond their control Signature over printed name of Parent AGREEMENT I hereby agree to the rules and regulations set by the organizers and that | will be held responsible for any loss or damage of the venue's facilities Signature over printed name of Adviser FOOD RESTRICTIONS: SPECIAL MEDICATION/S ‘NEEDED: NYSTESC Secretariat Philippine Society of Youth Science Clube Unit 703 West Mansions Cancaminiam, Zamboanga St Brgy. Nayang Kanluran, Quezon Cty 1104 ‘Telephone: (02)399-4984 | Telefax: (02)932-8151 E-mail: mail@psysc org JOINING COMPETITONS? [heck al tht amps) Lnescuerade (set ncearch congest Lscteotaue see Dsustcrenay Lewin cnenay Diratcree (oleae nferta te ctachea Comparative Sir size Chart Heo please note thet shireszes wil ony be guaranteed if you submit our Registration formson er before narch 2011) Doreen sma Desire tree lesrrasmat! Dweaium Dune